Prior to MLTC plan members attending a new SADC, the MLTC plan must complete an initial evaluation which will verify that the new SADC site is compliant with all state and federal regulations. Refer to the Ongoing Monitoring of SADC section below for details on the evaluation and the DOH SADC Site Evaluation tool.

Steps MLTC plans are required to take are as follows:

• Identify the SADC site to contract with.
• Make sure the SADC site is compliant with all applicable state and federal regulations by performing an initial evaluation of the SADC.
• Work with the SADC site to remediate any non-compliance and ensure all remediation efforts are completed prior to members attending that SADC site.
• Execute a contract with the SADC site that includes:
  • Date of the contract.
  • NYS requirements for standard clauses.
  • The requirements for SADC contracts.
• The MLTC plan should also add the new SADC site to their network via the next quarterly Provider Network Data System (PNDS) submission.
  • For additional details on PNDS submission requirements, please see the section - PNDS Updates of SADC Network.

Responsibilities

The MLTC plans are required to do an initial site visit prior to contracting with the SADC as described above and then an annual evaluation of all contracted SADC sites to ensure each contracted SADC site is maintaining compliance with all state and federal regulations. DOH suggests using the SADC Site Evaluation Tool to perform ongoing reviews of the members enrolled at each SADC. If using a different tool, it must contain at a minimum all fields from the DOH's tool. Additional guidance on the evaluation regulations can be found at the links below:

• 9 CRR-NY 6654.20
• HCBS Final Rule
• SADC Annual Certification
  • Office of the Medicaid Inspector General (OMIG) Portal for Certification

Reminders

• Complete required remediation of non-compliant areas for the SADCs.
• Save all documents and proof of remediation for at least 6 years and be prepared to share the documentation with DOH, OMIG, or Office of Inspector General (OIG) upon request.
• Perform person centered planning, using the SADC HCBS compliant Person Centered Service Plan Template. For additional details on the PCSP process please visit NYS DOH Person Centered Planning Guidelines Home Page.

Resources

• Suggested SADC Site Evaluation Tool for MLTC Plans (Excel)
  • Suggested SADC Site Evaluation Tool Guide
  • Suggested SADC Site Evaluation Tool Video Tutorials
• SADC/SADS Person Centered Service Plan (PCSP) Template

If a SADC site is temporarily closing for any reason, the MLTC plan is responsible for ensuring the SADC has a procedure in place to notify the MLTC plan and that member's attending that SADC are assisted with any needs in the interim or outreach to educate and transfer members to another HCBS-compliant SADC site.

Responsibilities

• DOH suggests that the MLTC plan have a procedure in place with the SADC that requires the SADC provide at least a 30-day notice to the MLTC plan for extended temporary closure such as building maintenance or remodeling.
• DOH suggests that the MLTC plan also have a procedure in place with the SADC that requires they give notice to the MLTC plan as soon as possible for an emergency temporary closure, such as inclement weather.
• Once notified of a temporary closure, the MLTC plan is responsible for ensuring any applicable member backup plans are initiated and/or other temporary needs are met.

If a SADC site is permanently closing, the MLTC plan is responsible for ensuring the SADC site has a procedure in place to notify the MLTC plan in ample time for the MLTC plan to ensure members' services are not disrupted and to perform the transfer PCP process with another SADC site.

Responsibilities

• DOH suggests that the MLTC plan have a procedure in place with the SADC that requires the SADC provide at least a 60-day notice to the MLTC plan for permanent closure.
• Once notified of a permanent closure, the MLTC plan is responsible for outreach to attending members to educate and transfer members to another HCBS-compliant site and performing the PCP process transfer.
• The MLTC plan should also remove the SADC from their network via the next quarterly Provider Network Data System (PNDS) submission.
  • For additional details on PNDS submission requirements, please see the - PNDS Updates of SADC Network section.

When a SADC site relocates to a new address or location within an existing building, it is considered a new SADC at the new location and permanent closure of the SADC at the original location.

The MLTC plan must conduct all steps for the new location found in the Contracting With a New SADC section above, which includes conducting the initial visit prior to contracting with the new location, AND all steps for the original location found in the permanent closure section above. Additionally, the responsibilities listed below are also required.

Responsibilities

• To align with handling a permanent closure, DOH suggests that the MLTC plan have a procedure in place with the SADC site that requires the SADC site provide at least a 60-day notice to the MLTC plan when relocating the SADC site.
• The MLTC plan should also remove the original SADC location/address from their network and add the new SADC site location/address via the next quarterly Provider Network Data System (PNDS) submission.
  • For additional details on PNDS submission requirements, please see the - Provider Network Data System (PNDS) Updates of SADC Network section below.

Important: Please note that the MLTC plan MUST perform the PCP process to discuss with the member if they would like to attend the new location or if they prefer to receive SADC services elsewhere. Member should never be transferred to a new SADC location without a PCP discussion.

Each year DOH verifies that SADC are compliant with HCBS Settings Final Rule and MLTC plans are required to support DOH in coordinating verifications and validations with their contracted SADC sites.

For detailed guidance on the roles and responsibilities of MLTC plans, SADCs, and DOH, in relation to the SADC HCBS Compliance Verification Reviews, please visit the SADC HCBS Compliance Review Process - Roles and Responsibilities webpage.

MLTC plans are required to complete initial and annual site evaluations on all contracted SADC sites in the plans network, to ensure that the site is compliant with applicable state and federal regulations (as described above in the Ongoing Monitoring of SADC Compliance section) along with providing ongoing monitoring and oversight of the plan's contracted SADCs.

DOH is responsible for monitoring the MLTC plan's annual oversight of their contracted SADCs. MLTC plans are responsible for responding and supporting DOH surveys of the MLTC plan's oversight of their contracted SADC sites.

Responsibilities

• Respond to DOH requests for information needed to conduct the verification and validation survey.
  • For example, supplying initial and annual SADC site evaluations, along with proof of remediation.
• Submit all requested documentation to DOH, by the requested due date.
• Work with DOH to remediate any non-compliance identified and implement a corrective action plan (CAP) to prevent the non-compliance in the future.

Note: Any inquiries on DOH survey efforts can be sent to mltcsurvey@health.ny.gov.

MLTC plan administrators are required to submit quarterly reports via the PNDS portal. These reports are meant to detail all active provider and facility (ancillary) contracts they have for that quarter, including contracted SADC sites.

Responsibilities

• Add new SADC site to the plan's network via the next quarterly PNDS submission.
• Remove closed SADC sites from the network via the next quarterly PNDS submission.
• Remove SADC sites no longer contracted with.
• Report SADC site service location and not business address.
• Do not report an Adult Day Health Care (ADHC) as a SADC.
• The MLTC plan must submit their proposed contract list for network adequacy verification to DOH at MLTC.PNDS@health.ny.gov.

Reminders

• Any questions regarding PNDS submissions can be sent to DOH at MLTC.PNDS@health.ny.gov.
• Addresses reported via PNDS should be the physical service location of the SADC site, not a business or mailing address.
• SADC site names should reflect the full and complete business name.
  • Note: If a business is operating a SADC under a name that does not match the business, the name should be report as a doing business as (DBA).
  • Ex. ABC, Inc. DBA XYZ Social Adult Day Care
• Verify that contracted SADC sites and Adult Day Health Care (ADHC) providers are appropriately tagged and not mislabeled as each other.
• Remove duplicate entries where the same SADC site is being reported.

Complaints regarding a SADC should be handled using the same grievance process outlined by the MLTC plan.

Responsibilities

• MLTC plans are required to investigate all SADC site-related complaints reported to them by the Technical Assistance Center (TAC) and members or their representative.
• DOH highly recommends an unannounced visit when investigating complaints.
• MLTC plans must maintain anonymity for all parties involved.
• MLTC plans are required to work with the contracted SADC site to remediate issues and if remediation is not possible, terminate their contract with the SADC.
• Respond to any inquiries from TAC or any other government agency involved, such as DOH, OMIG, or the New York City Department of Health and Mental Hygiene (NYC DOHMH).
• Ensure that a PCP session is held with any impacted members or members issuing the complaint to determine if the member wishes to change their SADC service provider or adjust their services.

Resources

• TAC Contact Information
  • Webpage: If you Have a Complaint about MLTC
  • Phone: 1-866-712-7197
  • Email: mltctac@health.ny.gov.